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CERTIFICATE OF COMPLIANCE
PLEASE TICK APPROPRIATE BOXES OR ENTER DETAILS IN BOXES BELOW
Customers Name:
Installation Address:
Installation Address:
Installation Address:
Installation Address:
Town:
County:
Installing Company Name:
Work Completion date
Installing Engineer's Name:
Companies Vat No.
Description of Work
Location:

Lounge
Appliance:


Dining Room

Kitchen

Dry Open Fire


Open Fire with Boiler
Dry Roomheater/Stove
Make
System:




New Heating and Hot Water System
Chimney:


Ridged Sectional Liner Metal


Cooker with Boiler
Independent Boiler
Heat Output
Kw
Updated Existing Heating and Hot Water System


Yes
No

Cast In-situ Liner
Existing Hearth/Surround Updated
Additional Information
mm
Diameter


Yes
Spigot down and gas tight:
Chimney Data Plate Location:
No
Has a permanently open air vent been fitted:
Is the vent opening at least 50% of cross sectional area of throat/flue:
State total free area of air vent:

Ridged Sectional Liner Other
New Hearth/Surround Fitted
Provision for sweeping chimney/fluepipes:
OR
Dry Cooker
Twin Wall Flexi Liner (for Class 1 Appliance)

Connecting fluepipes:
Air supply:

Other, Specify
New Insulated Factory Made Chimney System installed
Relining of Existing chimney:

Bedroom
Dry System Only
Is the Hot Water System Unvented?
Hearth:

Roomheater/Stove with Boiler
Model
If Wet System:

Utility Room

Yes

No

Yes

No
mm²
If no please explain:
Confirm an approved Carbon Monoxide alarm has been fitted:

Yes

No
Appliance Operation and Fuel
Does the customer have a copy of the appliance user’s manual:
 Yes  No
What types of fuels can be burned in the appliance:___________________________________________________________________________
What types of fuel are NOT suitable for use in this appliance:____________________________________________________________________
How many times per year is the appliance and flue system to be cleaned and inspected:______________________________________________
The end user/customer understands how to correctly operate the appliance:
 Yes  No
Testing & Commissioning to Section J of the Building Regulations
Confirm you have commissioned and tested the appliance & associated work for safe and efficient operation
Declaration of completion As the competent person responsible for the work described above, I confirm that the application and associated
work has been installed in accordance with building regulations, and that the work complies with as such the appliance and flue system are fit
for purpose and safe to operate.
Fitter signature:________________________________Print Name:__________________________________________Date:_______________
Customer signature:_____________________________Print Name__________________________________________Date:_______________
THIS CERTIFICATE SHOULD BE RETAINED BY THE PROPERTY OWNER
WHO MAY BE REQUIRED TO PRODUCE IT IN ANY FUTURE SALE OF THE PROPERTY